The birth of a preterm infant represents a major crisis for parents that may impact their performance of parenting occupations.
Purpose.
The purpose of the study was to explore the experiences that enable parents to participate in occupations associated with the role of parenting in a neonatal intensive care unit (NICU).
Method.
A paradigmatic analysis of narratives was completed based on interviews conducted with six parents of preterm infants.
Findings.
Six themes were identified: anticipating occupations versus reality, needing emotional resilience, working to reclaim the parental role, navigating the NICU occupation–environment transactions, building and maintaining relationships with staff, and revisioning the future.
Implications.
The use of an occupation-based approach moves parents’ involvement in the NICU beyond basic caregiving occupations. It highlights the importance of providing opportunities for nurturing and caring for their infants in ways that are meaningful to their identity as a parent.
American Occupational Therapy Association, Neonatal Intensive Care Unit Task Force. (1993). Knowledge and skills for occupational therapy practice in the neonatal intensive care unit. American Journal of Occupational Therapy, 47, 1100–1105. doi:10.5014/ajot.47.12.1100
2.
BlencoweH.CousensS.ChouD.OestergaardM.SayL.MollerA.…Born Too Soon Preterm Birth Action Group. (2013). Born too soon: The global epidemiology of 15 million preterm births. Reproductive Health, 10(Suppl. 1), S2. doi:10.1186/1742-4755-10-S1-S2
3.
BusseM.StromgrenK.ThorngateL.ThomasK. A. (2013). Parents’ responses to stress in the neonatal intensive care unit. Critical Care Nurse, 33(4), 52–59. doi:10.4037/ccn2013715
Cescutti-ButlerL.GalvinK. (2003). Parents’ perceptions of staff competency in a neonatal intensive care unit. Journal of Clinical Nursing, 12, 752–761. doi:10.1046/j.1365-2702.2003.00783.x
6.
ChristiansenC. (1999). Defining lives: Occupation as identity. An essay on competence, coherence and the creation of meaning. American Journal of Occupational Therapy, 53, 547–558. doi:10.5014/ajot.53.6.547
7.
Department of Health. (2003). Report of the Neonatal Intensive Care Services Review Group. London, UK: Department of Health.
Dudek-ShriberL. (2004). Parent stress in the neonatal intensive care unit and the influence of parent and infant characteristics. American Journal of Occupational Therapy, 58, 509–520. doi:10.5014/ajot.58.5.509
10.
EasterbrooksM. A. (1988). Effects of infant risk status on the transition to parenthood. In MichaelsG. Y.GoldbergW. A. (Eds.), The transition to parenthood: Current theory and research (pp. 176–208). Cambridge, UK: Cambridge University Press.
11.
FenwickJ.BarclayL.SchmiedV. (2001). Struggling to mother: A consequence of inhibitive nursing interactions in the neonatal nursery. Journal of Perinatal and Neonatal Nursing, 15(2), 49–64. doi:10.1097/00005237-200109000-00005
12.
FenwickJ.BarclayL.SchmiedV. (2002). Learning and playing the game: Women’s experiences of mothering in the level II nursery. Journal of Neonatal Nursing, 8, 58–64.
13.
FranckF. S.AxelinA. (2013). Differences in parents’, nurses’ and physicians’ views of NICU parent support. Acta Paediatrica, 102, 590–596. doi:10.1111/apa.12227
14.
GaleG.FranckL. S. (1998). Toward a standard of care for parents of infants in the neonatal intensive care unit. Critical Care Nurse, 18(5), 62–74.
15.
GaveyJ. (2007). Parental perceptions of neonatal care. Journal of Neonatal Nursing, 13, 199–206. doi:10.1016/j.jnn.2007.06.001
16.
GibbsD. P. (2011). Occupational adaptation of parents of preterm infants in the neonatal intensive care unit: An interpretive descriptive study (Doctoral dissertation). Retrieved from UniSA Research Archive (oai:ura.unisa.edu.au:60539)
17.
GibbsD.BoshoffK.LaneA. (2010). Understanding parenting occupations in neonatal intensive care: Application of the Person-Environment-Occupation Model. British Journal of Occupational Therapy, 73, 55–63. doi:10.4276/030802210X12658062793762
18.
GibbsD.BoshoffK.StanleyM. (2015). Occupational adaptation of parents of preterm infants: A meta-ethnographic synthesis. British Journal of Occupational Therapy, 78, 475–487. doi:10.1177/0308022615586799
19.
GoodingJ. S.CooperL. G.BlaineA. I.FranckF. S.HowseJ. L.BernsS. D. (2011). Family support and family-centered care in the neonatal intensive care unit: Origins, advances, impact. Seminars in Perinatology, 35, 20–28. doi:10.1053/j.semperi.2010.10.004
20.
GorgaD.AnzaloneM.HollowayE.BigsbyR.HunterJ.StrzyewskiS.VergaraE. (2000). Specialized knowledge and skills for occupational therapy practice in the neonatal intensive care unit. American Journal of Occupational Therapy, 54, 641–648. doi:10.5014/ajot.54.6.641
21.
GriffinT. (2006). Family-centered care in the NICU. Journal of Perinatal and Neonatal Nursing, 20, 98–102. doi:10.1097/00005237-200601000-00029
22.
HarrisonH. (1993). The principles for family-centered neonatal care. Pediatrics, 92, 643–650.
23.
HeermanJ. A.WilsonM. E.WilhelmP. A. (2005). Mothers in the NICU: Outsider to partner. Pediatric Nursing, 31, 176–181, 200.
24.
Holditch-DavisD.MilesM. S. (2000). Mothers’ stories about their experiences in the neonatal intensive care unit. Neonatal Network, 19(3), 13–21. doi:10.1891/0730-0832.19.3.13
25.
HollowayE. (2008). Fostering early parent–infant playfulness in the neonatal intensive care unit. In ParhamL. D.FazioL. S. (Eds.), Play in occupational therapy for children (pp. 335–350). St Louis, MO: Mosby Elsevier.
26.
JohnsonB. H. (1995). Newborn intensive care units: Pioneer family-centered change in hospitals across the country. Zero to Three, 15(6), 11–17.
27.
JosephssonS.AsabaE.JonssonH.AlsakerS. (2006). Creativity and order in communication: Implications from philosophy to narrative research concerning human occupation. Scandinavian Journal of Occupational Therapy, 13, 86–93. doi:10.1080/11038120600691116
28.
KreftingL. (1991). Rigor in qualitative research: The assessment of trustworthiness. American Journal of Occupational Therapy, 45, 214–222. doi:10.5014/ajot.45.3.214
29.
LantzB.OttossonC. (2012). Parental interaction with infants treated with medical technology. Scandinavian Journal of Caring Sciences, 27, 597–607. doi:10.1111/j.1471-6712.2012.01061.x
30.
LimperopoulosC.MajnemerA. (2002). The role of rehabilitation specialists in Canadian NICUs: A national survey. Physical and Occupational Therapy in Pediatrics, 22(1), 57–72. doi:10.1300/j006v22n01_05
31.
LincolnY. S.GubaE. A. (1985). Naturalistic inquiry. Beverly Hills, CA: Sage.
32.
LuptonD.FenwickJ. (2001). “They’ve forgotten that I’m the mum”: Constructing and practising motherhood in special care nurseries. Social Science and Medicine, 53, 1011–1021. doi:10.1016/s0277-9536(00)00396-8
33.
McCanceT. V.McKennaH. P.BooreJ. R. P. (2001). Exploring caring using narrative methodology: An analysis of the approach. Journal of Advanced Nursing, 33, 350–356. doi:10.1046/j.1365-2648.2001.01671.x
34.
McGrathJ. M.Conliffe-TorresS. (1996). Integrating family-centered developmental assessment and intervention into routine care in the neonatal intensive care unit. Nursing Clinics of North America, 31, 367–386.
35.
MoehnD. G.RossettiL. (1996). The effects of neonatal intensive care on parental emotions and attachment. Infant-Toddler Intervention, 6, 229–246.
36.
OlsonJ. A. (2004). Mothering occupations in caring for infants and young children. In EsdaileS. A.OlsonJ. A. (Eds.), Mothering occupations: Challenge, agency and participation (pp. 28–51). Philadelphia, PA: F. A. Davis.
37.
ParsonsL.StanleyM. (2008). The lived experience of occupational adaptation following acquired brain injury for people living in a rural area. Australian Occupational Therapy Journal, 55, 231–238. doi:10.1111/j.1440-1630.2008.00753.x
38.
PattonM. (1990). Qualitative evaluation and research methods. Beverly Hills, CA: Sage.
39.
PolatajkoH. J.DavisJ. A. (2012). Advancing occupation-based practice: Interpreting the rhetoric [Editorial]. Canadian Journal of Occupational Therapy, 79, 259–260. doi:10.2182/cjot.2012.79.5.1
40.
PolkinghorneD. E. (1995). Narrative configuration in qualitative analysis. International Journal of Qualitative Studies in Education, 8, 5–25. doi:10.1080/0951839950080103
41.
PriceP. (2003). Occupation-centered practices: Providing opportunities for becoming and belonging. Dissertation Abstracts International, 65(05), 2382B. (UMI No. 3133327)
42.
ReisM. D.RempelG. R.ScottS. D.Brady-FryerB. A.Van AerdeJ. (2010). Developing nurse/parent relationships in the NICU through negotiated partnership. Journal of Obstetric, Gynecological & Neonatal Nursing, 39, 675–683. doi:10.1111/j.1552-6909.2010.01189.x
43.
SallinenM.KukkurainenM. L.PeltokallioL.MikkelssonM. (2011). “I’m tired of being tired”: Fatigue as experienced by women with fibromyalgia. Advances in Physiotherapy, 13, 11–17. doi:10.3109/14038196.2010.546880
44.
SchappinR.WijnroksL.Uniken VenemaM. M. A. T.JongmansM. J. (2013). Rethinking stress in parents of preterm infants: A meta-analysis. PLoS ONE, 8, e.54992. doi:10.1371/journal.pone.0054992
45.
SchkadeJ. K.SchultzS. (1992). Occupational adaptation: Toward a holistic approach for contemporary practice, Part 1. American Journal of Occupational Therapy, 46, 829–837. doi:10.5014/ajot.46.9.829
46.
SmithV. C.SteelFisherG. K.SalhiC.ShenL. Y. (2012). Coping with the neonatal intensive care unit experience. Journal of Perinatal and Neonatal Nursing, 26, 343–352. doi:10.1097/jpn.0b013e318270ffe5
47.
ThorneS.Reimer-KirkhamS.MacDonald-EmesJ. (1997). Interpretive description: A noncategorical qualitative alternative for developing nursing knowledge. Research in Nursing and Health, 20, 169–177. doi:10.1002/(sici)1098-240x(199704)20:2<169::aid-nur9>3.3.co;2-b
VergaraE.AnzaloneM.BigsbyR.GorgaD.HollowayE.HunterJ.…StrzyzewskiS. (2006). Specialized knowledge and skills for occupational therapy practice in the neonatal intensive care unit. American Journal of Occupational Therapy, 60, 659–668. doi:10.5014/ajot.60.6.659
50.
VrkljanB. H.PolgarJ. M. (2007). Linking occupational participation and occupational identity: An exploratory study of the transition from driving to driving cessation in older adulthood. Journal of Occupational Science, 14, 30–39. doi:10.1080/14427591.2007.9686581
51.
WereszczakJ.MilesM. S.Holditch-DavisD. (1997). Maternal recall of the neonatal intensive care unit. Neonatal Network, 16(4), 33–40.
52.
WestrupB. (2007). Newborn Individualised Developmental Care and Assessment Program (NIDCAP): Family-centered developmentally supportive care. Early Human Development, 83, 443–449. doi:10.1016/j.earlhumdev.2007.03.006
53.
WhitfieldM. F. (2003). Psychosocial effects of intensive care on infants and families after discharge. Seminars in Neonatology, 8, 185–193. doi:10.1016/s1084-2756(02)00218-x
54.
WicksA.WhitefordG. (2003). Value of life stories in occupation-based research. Australian Occupational Therapy Journal, 50, 86–91. doi:10.1046/j.1440-1630.2003.00357.x
55.
WigertH.HellströmA. L.BergM. (2007). Conditions for parents’ participation in the care of their child in neonatal intensive care: A field study. BMC Pediatrics, 8, Article 3. doi:10.1186/1471-2431-8-3
56.
WisemanL.WhitefordG. (2009). Understanding occupational transitions: A study of older rural men’s retirement experiences. Journal of Occupational Science, 16, 104–109. doi:10.1080/14427591.2009.9686649
57.
YerxaE. J. (1991). Seeking a relevant, ethical and realistic way of knowing for occupational therapy. American Journal of Occupational Therapy, 45, 199–204. doi:10.5014/ajot.45.3.199
